Symptom-Based Diagnosis: The Rome IV criteria emphasize diagnosing functional gastrointestinal disorders (FGIDs) in children and adolescents based on symptoms rather than the exclusion of organic diseases. The phrase „no evidence of an inflammatory, anatomic, metabolic, or neoplastic process“ has been removed, allowing for selective or no testing to support a positive diagnosis.
Coexistence with Other Conditions: The criteria acknowledge that FGIDs can coexist with other medical conditions, which may also cause gastrointestinal symptoms. This understanding allows for a more comprehensive approach to diagnosis and treatment.
New Disorders Included: Rome IV introduces two new disorders: functional nausea and functional vomiting, expanding the scope of recognized FGIDs in children and adolescents.
Changes in Diagnostic Criteria: The criteria for diagnosing functional abdominal pain disorders (FAPDs) have been updated. The frequency of abdominal pain required for diagnosis has been changed from weekly to four times per month, and the term „functional abdominal pain—not otherwise specified“ (FAP-NOS) has been introduced to describe children who do not fit specific disorders like irritable bowel syndrome (IBS) or functional dyspepsia.
Harmonization with Adult Criteria: The wording „that does not occur solely during physiologic events (e.g., eating, menses)“ has been added to align with adult criteria, reflecting that symptoms may worsen during these events but also occur at other times.
Aerophagia in Pediatrics: While aerophagia has been removed from the adult Rome IV classification, it remains recognized in pediatrics due to its distinct pathophysiological features in children, such as excessive air swallowing leading to symptoms like belching and abdominal distention.
A paper from Hyams et al. (2026) aims to update the diagnostic criteria for childhood and adolescent functional gastrointestinal disorders (FGIDs) in the Rome IV guidelines, emphasizing symptom-based diagnosis over exclusion of organic disease.
These updates aim to provide clearer guidelines for clinicians and researchers, facilitating better diagnosis and management of FGIDs in the pediatric population
The article reviews and synthesizes existing literature and expert consensus to revise the diagnostic criteria for FGIDs in children and adolescents.
The Rome IV criteria allow for a positive diagnosis of FGIDs without exhaustive testing, acknowledging that FGIDs can coexist with other medical conditions.
Weaknesses of the article is that it does not provide specific empirical data or new experimental findings, relying instead on expert consensus and literature review.
Conclusion for Osteopaths: Osteopaths should consider the updated Rome IV criteria when assessing gastrointestinal symptoms in children, focusing on symptom-based diagnosis and the potential coexistence of FGIDs with other conditions.
Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Functional Disorders: Children and Adolescents. Gastroenterology, S0016-5085(16)00181-5. Advance online
publication. https://doi.org/10.1053/j.gastro.2016.02.015